Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(9):e44663.
doi: 10.1371/journal.pone.0044663. Epub 2012 Sep 13.

A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys

Pauline M L Hennus  1 , Geert J M G van der Heijden, J L H Ruud Bosch, Tom P V M de Jong, Laetitia M O de Kort
Affiliations

A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys

Pauline M L Hennus et al. PLoS One. 2012.

Abstract

Background: Posterior urethral valves (PUV) may cause subtle to severe obstruction of the urethra, resulting in a broad clinical spectrum. PUV are the most common cause of chronic renal disease in boys. Our purpose was to report the incidences of kidney and bladder dysfunction in boys treated with endoscopic valve resection for PUV.

Methodology: We searched MEDLINE and EMBASE databases until 1st of July 2011, to identify original papers that described outcome of endoscopic valve resection (EVR) in boys. We extracted information on (1) patient characteristics and clinical presentation of PUV related to outcomes and (2) the post-treatment absolute risks for kidney and bladder dysfunction.

Principal findings: Thirty-four studies describing renal function, vesicoureteral reflux (VUR), incontinence, and urodynamic bladder function after EVR in 1474 patients were retrieved. Patients treated for PUV show high percentages of chronic kidney disease (CKD) or end stage renal disease (ESRD), 22% (0-32%) and 11% (0-20%), respectively. Elevated nadir serum creatinine was the only independent factor associated with renal failure. Before treatment, VUR was present in 43% of boys and after EVR, VUR was present in 22%. Post treatment, 19% (0-70%) was reported to suffer from urinary incontinence. Urodynamic bladder dysfunction was seen in many patients (55%, 0-72%) after treatment of PUV.

Conclusions: The reported cumulative incidence of renal and bladder dysfunction in patients with PUV after endoscopic PUV treatment varies widely. This may reflect a broad clinical spectrum, which relates to the lack of a standardised quantification of obstruction and its severity. Moreover, the risk of bias is rather high, and therefore we put little confidence in the reported estimates of effect. We found elevated nadir serum creatinine as a predictor for renal dysfunction. In order to be able to predict outcomes for patients with PUV, an objective classification of severity of obstruction is mandatory.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow-chart.
See this image and copyright information in PMC

References

    1. Pieretti RV (1993) The mild end of the clinical spectrum of posterior urethral valves. J Pediatr Surg 28 5:701–4 discussion 704–6. - PubMed
    1. Hendren WH (1971) Posterior urethral valves in boys. A broad clinical spectrum. J Urol 106 2:298–307. - PubMed
    1. Smith GH, Canning DA, Schulman SL, Snyder HM 3rd, Duckett JW (1996) The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol 155 5:1730–1734. - PubMed
    1. Close CE, Carr MC, Burns MW, Mitchell ME (1997) Lower urinary tract changes after early valve ablation in neonates and infants: Is early diversion warranted? J Urol 157 3:984–988. - PubMed
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med 6 7:e1000100. - PMC - PubMed

Publication types